Is Xylitol a Healthy Option for Your Teeth?

Xylitol was discovered over a century ago and was approved for human consumption by the FDA in 1963, but it has only recently become popular. It is used as a sugar substitute in some foods, gum, and mints, and in toothpaste and other dental products to work with or replace fluoride. There are many claims about the benefits for your body and dental health. Are any of them true, or is xylitol another passing fad?


The truth about Xylitol.


Xylitol is a naturally occurring sweetener found in Birch trees, Beech trees, and many vegetables and fruits. Our bodies also create a small amount whenever we metabolize carbohydrates.


It is as sweet as sucrose. Sucrose is the ingredient that makes many foods sweet, including granulated sugar, powdered sugar, brown sugar, maple syrup, honey, and coconut sugar. Although it is a naturally occurring compound, too much sucrose can harm your body in many ways. Two negative effects of sucrose are that it causes an insulin spike and it feeds harmful, cavity-causing bacteria in your mouth.


Xylitol, although sweet like sucrose, is treated differently when processed by the human body. It has a very low glycemic index of 7, so it does not cause an insulin spike. Additionally, it has 40% fewer calories than the equivalent amount of table sugar, allowing you to experience the same level of sweet taste while consuming fewer calories.


What about the claims regarding xylitol and dental health?


Can it really reduce the chance of developing cavities or remineralize your teeth?


Strangely enough, when consumed in sufficient amounts regularly throughout the day, it can minimize the development of cavities. One of the main ways it does this is through reducing the amount of mutans streptococci bacteria in the mouth, which is one of the biggest culprits in cavity formation.


Multiple studies have documented xylitol’s effectiveness in reducing cavities (1, 2, 3). One follow-up study discovered that children who had used xylitol gums daily during the study still had significantly fewer cavities five years later (4).


Some studies have also shown that in certain conditions cavities stop growing, and even get smaller over years of adequate use of xylitol (5).


How it works.


Usually, when you eat, certain strains of bacteria in your mouth consume and ferment sugars to create energy so the bacteria can live. Acid is created as a byproduct. The acid eats away tooth enamel, causing tooth decay. The bacteria also form plaque, which causes gum disease and increases the rate of tooth decay.


When you consume xylitol, the bacteria feed on it like a normal food source. However, the bacteria cannot ferment xylitol. Since fermentation is not happening, the bacteria are not able to thrive and reproduce. They also do not produce acid as a byproduct, which means that acid is not wearing away enamel.


At the same time, the bacteria use up a ton of energy trying to use xylitol for energy. Eventually, they expel it. Another bacterium will take it up and go through the same process. When you consume xylitol in the correct quantities at regular intervals throughout the day, the cavity-causing bacteria basically starve to death. This process is called a “futile metabolic cycle” and does two things: reduces the number of harmful bacteria in the mouth and allows room for beneficial bacteria colonies to form.

Researchers believe that remineralization may happen because pH levels in the mouth are higher during regular consumption of xylitol. This reduces the amount of time that plaque can cause demineralization and allows calcium and phosphate in saliva to be absorbed by teeth (3).


It is interesting to note that children’s oral bacteria colonies are greatly impacted by their mother’s oral bacteria. One noteworthy study observed children whose mothers who began chewing xylitol gum two or three times a day when the child was three months old. At 24 months these children had far smaller amounts of mutans streptococci in their mouths than those whose mothers did not use xylitol (6). Although the children did not consume xylitol, the mothers transmitted less harmful bacteria. This allowed the child to develop beneficial bacteria colonies, which prevented the growth of harmful bacteria colonies.


Is it safe?


Xylitol is safe for humans. The only side effect noted was occasional gastrointestinal upset when a few people consumed more than 50-100 grams at once. The effects wore off quickly. This should not matter for most people, because the recommended amount is only 5-7 grams per day. Additionally, most of the people in the test did not notice any ill effects even in those large quantities.


Xylitol does work differently in the bodies of dogs and, like chocolate, is harmful to them. It is important to keep all products containing xylitol where your dog cannot accidentally consume it.



Recommendations.


For xylitol to starve bacteria and raise pH levels in the mouth, it does need to be used regularly. You can’t expect to brush your child’s teeth with a toothpaste containing small amounts of xylitol once or twice a day and see positive results.


To benefit from using xylitol, you need around 5-6 grams per day. You also need multiple exposures throughout the day, so it will have the desired effect on harmful bacteria all day long.


A recommended practice is to use 1-2 grams of xylitol at a time, 3–5 times a day.

If you have small children, begin using xylitol a few times a day. As discussed above, it will reduce the number of harmful bacteria in your saliva. This will minimize their exposure, allowing their mouth to develop a healthier balance of oral bacteria.

You can start brushing your baby’s teeth with a xylitol-rich toothpaste as soon as their first tooth appears.


If you can find a toothpaste with both xylitol and fluoride, you will gain the maximum benefit for your family’s oral health. It will help reduce the amounts of harmful bacteria, raise pH levels, and allow teeth to absorb fluoride that fortifies enamel. Children can begin using toothpaste with fluoride in it once they turn three. If you are concerned about the health effects of fluoride, please read this article on current research, recommended usage, and safety guidelines.


Whether you choose to use xylitol in food, gum, candies, or toothpaste, it is a great choice for your family. It keeps your mouth healthy and helps reduce overall sugar consumption. When used with regular brushing, flossing and dental checkups, xylitol is a valuable tool that will help your entire family enjoy a lifetime of dental health.


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At Jungle Roots Children’s Dentistry & Orthodontics, we strive to provide the highest comprehensive pediatric and orthodontic dental care in a unique, fun-filled environment staffed by a team of caring, energetic professionals. We believe the establishment of a “dental home” at an early age is the key to a lifetime of positive visits to the dentist.


1. Mäkinen K, K: Sugar Alcohol Sweeteners as Alternatives to Sugar with Special Consideration of Xylitol. Med Princ Pract 2011;20:303-320. doi: 10.1159/000324534


2. Nayak, P. A., Nayak, U. A., & Khandelwal, V. (2014). The effect of xylitol on dental caries and oral flora. Clinical, cosmetic and investigational dentistry, 6, 89–94. doi:10.2147/CCIDE.S55761


3. Maguire A, Rugg-Gunn AJ. Xylitol and caries prevention-is it a magic bullet? Br Dent J 2003;194:429–36. 10.1038/sj.bdj.4810022


4. Isokangas P, Mäkinen KK, Tiekso J, Alanen P. Long-term effect of xylitol chewing gum in the prevention of dental caries: a follow-up 5 years after termination of a prevention program. Caries Res. 1993;27(6):495–498.


5. Kandelman D, Gagnon G. Clinical results after 12 months from a study of the incidence and progression of dental caries in relation to consumption of chewing-gum containing xylitol in school preventive programs. J Dent Res 1987; 66: 1407– 1411.


6. Soderling E, Isokangas P, Pienihakkinen K, Tenovuo J. Influence of maternal xylitol consumption on acquisition of mutans streptococci by infants. J Dent Res 2000; 79: 882– 887.


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